What’s the difference between a psychologist and a psychiatrist?

When I’m asked this question, the standard answer is: “well, a psychiatrist is a medical doctor who can prescribe medications whereas a psychologist is a doctor in philosophy (or psychology) and does not prescribe medications” to which follows the following standard reply: “oh I see, so a psychologist is not a real doctor”. Haha. In my early years as a therapist, I used to get defensive when on the receiving end of that line, but since I have come to appreciate the value of psychotherapy and the intricacies of the mind, I now embrace the fact that psychologists can’t prescribe medications and I’m glad I’m not a real doctor.

Psychiatrists are Monists

It has not always been the case, but in the last 50 years or so, psychiatry has purposely and decisively moved toward becoming a biological science. At the risk of simplifying current psychiatric thinking, the dominant position in the discipline is that if you understand how the brain works, you will be able to treat psychiatric disorders. In other words, if you understand the brain, you understand the mind. Had psychiatry not adopted such an extreme reductionistic position, I think psychology would have remained largely confined to its roots, in the halls of academia studying normal psychological processes. But as psychiatry has trained its attention on the brain, psychology has stepped in to fill its void, becoming the dominant discipline interested in the study of the mind.

Psychologists are a mixed bag

Psychology’s stance in the mind/body debate is more complicated and diverse. Some, mostly behaviourists are staunch monists, who believe psychologists should concern themselves with the study (and treatment) of observable behaviour and leave the unseen processes of the mind to charlatans. Most, including myself are staunch dualists, we, I believe that the workings of the mind (not just behaviour) both normal and disturbed is our science.

Why I am a Dualist

I’d like to start by saying that there is no doubt in my mind (no pun intended) that without the brain there can be no mind. I don’t want to be lumped in with spiritual gurus and afterlifers please. But I also have no doubts that the mind “emerges” from the brain. Framed this way, I know I’m on firm ground because the concept of “emergence” is a well-accepted philosophical concept. Without going into too much detail about the philosophy of emergence (because I’m not a philosopher), it’s the idea that complex systems tend to show new (emerging) properties that its components do not have. The human brain being a complex system, perhaps the most complex system in the universe, it is not a surprise that it shows emerging properties. I challenge monists to argue the contrary. An important consequence of emergence is that it is resistant to reductionism, meaning that you cannot study it by reducing it to the analysis of the component parts, and this is why I consider myself an emergent dualist.

The mind has a mind of its own

There is nothing wrong with studying the brain, I am a trained neuropsychologist and my Ph.D. thesis had a definite neuroscience flavour, but please don’t presume you’re going to understand the mind only by understanding the brain. That is a fool’s errand. Understanding Broadmann’s Areas architecture and especially interconnections can provide insights into how the mind works; learning more about the neurotransmitters that enable these interconnections is also very helpful. This and other insights from neuroscience are perhaps necessary but certainly not sufficient to understand how the mind works. A cliché metaphor but nevertheless apt here if one can appreciate a Paganini concert by studying a violin?

Classical and operant conditioning and their laws may have found support in activation studies, but one couldn’t have discovered these laws of the mind by just looking at the brain or brain scans. Likewise, Kahneman and Tversky’s heuristics, and Bowlby’s attachment system behviours would have been impossible to discover by just studying brain structure, activation or mix of neurotransmitters. I’ve read so many texts with titles with variations on “Consciousness, a neurobiological approach” and all have left me bitterly disappointed. Aside from the axiom that emergent properties of a complex system like the human brain cannot by definition be reducible, Steven Hayes, the founder of contextual science, notes that the mind responds to environmental cues including other minds; the importance of context in understanding how the mind works is another reason why you can’t understand the mind by just studying one brain. If you can’t appreciate the sound of a violin by just studying a violin, how can you even think one could even begin to  appreciate a concert of different instruments by just studying the physical properties of one of them?  

All this long-windedness to say that I will happily leave the brain and its chemical imbalances to the real doctors, the psychiatrists and neurologists. I am a psychologist, content to be a student of the mind.

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